Aim. To study the dynamics of office blood pressure (BP) levels, autonomic balance, endothelial dysfunction, and vascular remodelling in adolescents with Stage I arterial hypertension (AH), treated with indapamide retard (IR).
Material and methods. In total, the study included 41 adolescent boys, aged 16-18 years, with Stage I AH (main group, MG), and 27 healthy adolescents (control group, CG). The MG participants received, IR (1,5 mg/day) for 6 months. At baseline and in the end of the study, all participants underwent office BP measurement, echocardiography, veloergometry, and the assessment of heart rate variability (HRV), endothelial dysfunction (reactive hyperemia test, endotelin-1 levels), microalbuminuria (MAU), and vascular parameters, such as large artery rigidity and intima-media thickness.
Results. Target BP levels were achieved in all MG patients by Week 4 of the treatment, with normal BP values registered throughout the follow-up period. Indapamide therapy was associated with decreased hemodynamic cardiovascular load, normalized endothelial function, and MAU disappearance. IR monotherapy had beneficial effects on HRV, due to moderate parasympathetic stimulation.
Conclusion. IR is an effective and safe medication for long-term treatment of adolescents with Stage I AH.

Aim. To identify clinical and functional manifestations of hypervolemia in patients with arterial hypertension (AH).
Material and methods. In total, 440 patients with Stage I-II AH were examined, including assessment of salt taste sensitivity threshold (STST), 24-hour urinary Na excretion, and NaCl excretion. In addition, 24-hour blood pressure monitoring (BPM), echocardiography (EchoCG), and psychological status assessment (SMOL, MOS SF-36) were performed.
Results. In 50,5% of AH patients, daily salt intake (assessed by 24-hour NaCl excretion) was ≥16,8 g, due to adding salt to food, as well as to reduced STST. Higher salt intake was associated with more advanced clinical and functional AH manifestations. Indirect markers of hypervolemia in AH patients included higher salt intake, low effectiveness of standard antihypertensive therapy (AHT), disturbed circadian BP rhythm with inadequate nighttime BP reduction, and EchoCG signs of left ventricular volume overload.
Conclusion. Complex examination of AH patients helps to identify individuals with clinical and functional manifestations of hypervolemia.

Aim. To study quality of life (QoL), as an instrument for standardized assessment and monitoring of patients’ psychosocial status. Psychosocial approach is particularly important in diseases with psychosomatic component, such as essential arterial hypertension (EAH).
Material and methods. QoL was assessed in 101 adolescents (62 boys, 39 girls; age 14-17 years) with various EAH forms, as well as in 38 healthy adolescents (comparison group, CG). Based on the results of 24-hour blood pressure monitoring (BPM), all patients were divided into 3 groups: with white-coat hypertension (n=32); with labile AH (n=33); and with stable AH (n=36). QoL was assessed with the MOS SF-36 scale, measuring not only absolute QoL values, but also the “proxy-problem” phenomenon (the discrepancy between QoL reported by the patients themselves and their proxies – parents).
Results. Compared to the CG, adolescents with various BP levels demonstrated reduced QoL. QoL reduction was minimal in adolescents with white-coat hypertension, and maximal in patients with labile AH. In the latter group, both physical and psychological functioning parameters were reduced. The parents of EAH adolescents typically overestimated the severity of physical dysfunction of their children, while underestimating the magnitude of psychological dysfunction.
Conclusion. The results obtained confirm the important role of psychosomatic mechanisms in AH pathogenesis, and emphasize the need for psychiatrist or clinical psychologist’ participation in the treatment of hypertensive adolescents. In adolescents with stable AH, physical dysfunction was predominant.

Aim. To summarize the data on the 7-month treatment with ACE inhibitors (lisinopril) and hormone replacement therapy, HRT (femoston) – in particular, the effects on left ventricular (LV) structure and geometry, peripheral artery endothelium-dependent vasodilatation (EDVD), blood pressure (BP), and clinical perimenopausal symptoms – in premenopausal women with arterial hypertension (AH).
Material and methods. The study included 84 premenopausal women with Stage II AH and LV myocardial hypertrophy (LVH). Group I (47 women; mean age 48,6 years). The clinical symptoms included nighttime hyperhidrosis and hot flashes. In Group II (37 women, mean age 53,2 years). The clinical symptoms in Group II participants included hyperhidrosis, hot flashes, malaise, and dysphoria. Group II received lisinopril (1– mg/day) and femoston (2/10/2 mg); Group I was administered lisinopril in the same dose and placebo. Clinical examination, the measurement of BP and heart rate (HR), ECG, EDVD assessment, and echocardiography (EchoCG) were performed at baseline, during the treatment, and 7 months after the end of the treatment.
Results. Lisinopril therapy demonstrated a good antihypertensive effect in premenopausal women with AH, while also preventing the progression of LVH and dilatation of left heart chambers.
Conclusion. The studied medications improved peripheral artery endothelial function and were well tolerated. Femoston was highly compatible with cardiac therapy and effectively reduced clinical symptoms in premenopausal women with AH.

Aim. To investigate hemodynamic and ergometric parameters and their agreement with metabolic demand during veloergometry in patients with Stage I-II arterial hypertension (AH).
Material and methods. In total, 80 18-59-year-old men, with Stage I-II AH were examined, together with 25 healthy men of comparable body weight. All participants underwent standard veloergometry, with achievement of sub-maximal heart rate (HR), or development of test-termination criteria, such as excess blood pressure (BP) elevation, dyspnoea, or fatigue.
Results. A significant increase in myocardial oxygen consumption, disagreeing with metabolic demand, was observed both at rest and during veloergometry test. The qualitative criteria reflecting myocardial workload due to peripheral vascular resistance and functional myocardial remodelling were developed. These criteria differed at different AH stages, and included hemodynamic parameters (levels of systolic and diastolic BP) and ergometric characteristics (double product and its increase, pressure load index, and cardiac load index).
Conclusion. In Stage I-II AH patients, myocardial oxygen consumption during standard veloergometry was significantly higher than in healthy individuals, disagreed with metabolic demand, and increased with AH progression.

Aim. To assess vaso-regulating endothelial function and vascular tone auto-regulation status, in regard to arterial hypertension (AH) duration and stage, as well as to investigate the respective effects of antihypertensive therapy (AHT), in young men with AH.
Material and methods. The study included 49 men with Stage I-II AH (mean age 39,3±0,8 years), not treated before or treated irregularly. The controls were 22 men with normal blood pressure (BP) levels (mean age 37,5±1,7 years). The examination included 24-hour BP monitoring (BPM) and assessment of endothelium-dependent vasodilatation (EDVD) and time-adjusted mean arterial velocity (TAMX) in functional tests.
Results. In young men with Stage I-II AH, in contrast to normotensive men, EDVD and reactivity indices (RIs) were decreased in functional TAMX assessment tests. These changes in EDVD and RIs were observed even in patients with relatively short AH duration or Stage I AH. Effective AHT resulted not only in target BP level achievement, but also in normalisation of EDVD and vascular tone auto-regulation.
Conclusion. ACE inhibitors (lisinopril and enalapril) normalised EDVD and vascular tone auto-regulation parameters in young men with AH.

Aim. To assess the correlations between office and ambulatory blood pressure (BP) levels and some cardiovascular risk factors (RFs) in healthy young people and young people with BP dysregulation.
Material and methods. In total, 234 male and female students of the Stavropol State Medical Academy were examined (73 men, 161 women; age 18-23 years, mean age 21,4±0,2 years). The standard questionnaire included items on family history and behavioural risk factors. The examination also included anthropometry, psychological symptom questionnaire survey, office BP measurement, and ambulatory BP monitoring.
Results. RFs of cardiovascular disease (CVD) were widely prevalent in the students examined, with the rates in males being 2-3 times higher than in females. Arterial hypertension (AH) was presented by its labile forms – isolated office AH and masked AH. Participants with these AH forms, compared to healthy students, were characterized by a greater number and greater strength of the correlations between office or ambulatory BP parameters and some CVD RFs.

Conclusion. The association between labile AH and leading CVD RFs in young people points to the need for regarding individuals with labile AH as a risk group and for optimising preventive programs in students.

Aim. In patients with acute coronary syndrome (ACS), to investigate the prevalence of aspirin resistance, its clinical features, prognostic effects, and potential correction.
Material and methods. The study included 100 ACS patients receiving aspirin. Aspirin resistance was diagnosed if at Day 7 of aspirin therapy, the level of platelet aggregation (PLA) with arachidonic acid was ≥20%. In addition, a thromboxane A2 (ТхА2) metabolite – 11-dehydro-thromboxane B2 (11DHTxB2), as well as inflammation markers and genetic polymorphisms (sub-unit IIIa – Leu33Pro and cyclooxygenase-2 (COG) genes) were studied.
Results. Aspirin resistance was diagnosed in 11% of ACS patients, receiving aspirin in a standard dose of 100 mg/d. The majority of aspirin-resistant patients had ACS with ST segment elevation (STE-ACS). In all aspirin-resistant ndividuals, the resistance was pharmacokinetic. The level of 11DHTxB2, increased at baseline in ACS patients and especially in those with STE-ACS, was reduced during aspirin therapy. The combination of high PLA and high 11DHTxB2 levels was typically associated with true aspirin resistance. In patients with metabolite levels >438 ng/ mmol creatinine, prognosis was significantly worse than in those with lower levels of this parameter. In aspirinresistant patients, the levels of interleukin-6 (IL-6), IL-10, and C-reactive protein (CRP) at baseline and throughout the study were significantly higher than in aspirin-sensitive subjects. There was no significant association between aspirin resistance and Leu33Pro or А842G polymorphisms, while А842G polymorphism was more common in aspirin-resistant patients.
Conclusion. In aspirin-resistant patients, the level of ТхА2 metabolite is increased (true resistance). In ACS individuals with high levels of 11DHTxB2, the prognosis was worse. Aspirin resistance could be linked to inflammation activation. There was no consistent association between aspirin resistance and studied genetic polymorphisms.

Aim. To assess the associations between inflammatory factors and anxiety (A) and depression (D) levels in patients with myocardial infarction (MI).
Material and methods. The study included 100 MI patients, hospitalised with a diagnosis of Q-wave MI (mean age 62,0±1,3 years). The methods of psychosocial status assessment included Zung depression scale and SpielbergerKhanin personal and reactive anxiety scales. The inflammatory markers of interest included interleukins (IL) 1-beta, IL-6, IL-8, IL-10, and C-reactive protein (CRP).
Results. D and A symptoms in the early post-MI stage were associated with higher risk of cardiovascular events in the following year. Among MI patients with comparable MI severity, D and A symptoms were linked to higher levels of pro-inflammatory cytokines IL-1-beta, IL-8, IL-8, and INF-gamma.
Conclusion. In MI patients with D and A symptoms, one of the mechanisms of poor prognosis is an activation of subclinical inflammation.

Aim. To study the effects of long-term bisoprolol (B) therapy on exercise capacity (EC) dynamics, ventricular arrhythmia (VA), and clinical course in patients with myocardial infarction (MI).
Material and methods. The study included 114 men with MI (age 30-63 years), receiving long-term B treatment (2,5-10 mg once a day). The parameters assessed included EC dynamics, VA, and clinical course of the disease.
Results. Patients with sub-acute MI were characterised by low EC and VA presence, including life-threatening VA forms. Long-term B treatment was associated with a significant reduction in angina attack rate (by 3,9 times) and in the number of nitroglycerin tablets per week (by 4,3 times). In most patients (79,7%), B therapy increased the work performed during stress test (+99%), EC (+43,4%), and exercise time (+52%). In 44 patients (55,7%), an antiarrhythmic effect was observed, including the individuals with high-grade VA (13 out of 15). Long-term B treatment also improved the clinical course of the disease, significantly reducing the end-point rates (in 86,1%).
Conclusion. Early started, adequate-dose long-term B therapy improved clinical course of the disease and demonstrated good anti-ischemic, antianginal, and antiarrhythmic effects in MI patients, including those with life-threatening VA forms.

Aim. To assess the effectiveness of ivabradine-including therapy, as well as the effects of ivabradine on regulatoryadaptive status (RAS), in patients with chronic heart failure (CHF), Functional Class (FC) III.
Material and methods. The study included 100 patients with FC III CHF and coronary heart disease (CHD) and/ or Stage III arterial hypertension (AH). The participants were previously prescribed a complex treatment regime. After randomisation, Group I included 56 patients (mean age 62,9±1,8 years), who were additionally administered metoprolol succinate extended-release (mean dose 59,1±4,5 mg/day). Group II (n=44; mean age 59,4±1,3 years) was additionally administered an If channel inhibitor ivabradine, when beta-adrenoblocker (BAB) therapy was not possible. At baseline and 6 months later, participants underwent treadmill test (with VO2max assessment), echocardiography, 24-hour blood pressure monitoring, and the measurement of plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP). RAS status was qualitatively assessed in a cardio-respiratory synchronism test.
Results. Ivabradine-including therapy improved myocardial structure and function, increased exercise capacity, and demonstrated positive effects on plasma NT-proBNP levels, VO2мах during treadmill test, and RAS status.

Conclusion. Ivabradine could be an alternative medication when BAB therapy is not possible in patients with FC III CHF and CHD and/or Stage III AH.

Aim. To study clinico-demographical characteristics of the patients with decompensated chronic heart failure (CHF).
Material and methods. The analysis included the data of 112 patients hospitalised at Moscow City Clinical Hospital No. 68 due to decompensated CHF. The follow-up period lasted 30 days.
Results. The mean age of the patients (33 % men, 67 % women) was 70,3±9,9 years. Older age (>70 years) was significantly more prevalent in women than in men (р=0,005). The main reason for CHF decompensation was inadequate pre-hospital therapy. The mean duration of the in-hospital treatment was 17,5±6,4 days. The level of 30-day fatality was 12,5 % (n=14). According to correlation analysis results, systolic blood pressure (SBP) level <100 mm Hg positively correlated with 30-day fatality (r=0,4; р=0,0001). Hemoglobin level <100 g/l also positively correlated with 30-day fatality (r=0,3; р=0,05).
Conclusion. The prevalence of decompensated CHF is higher in women. Compared to men, women develop CHF in more advanced age. The main fatality-associated factors were low hemoglobin level, SBP <100 mm Hg, and age >70 years. The leading causes of death were pulmonary thromboembolism and diuretic therapy resistance.

Aim. To study the endothelial status, endothelial relaxation and constriction reserve, inflammation markers, and adipokines in men with metabolic syndrome (MS) and various forms of coronary heart disease (CHD).
Material and methods. In total, 236 male patients (mean age 56,5±2,07 years) were followed up. Serum levels of NO metabolites (NOnˉ), endothelin-1 (ET-1), and C-reactive protein (CRP) were measured, as well as the levels of cytokine system components (interleukin (IL) 6 and 10), tumor necrosis factor (TNF) alpha, and adipokines (leptin and adiponectin).
Results. Endothelial dysfunction was manifested in reduced levels of NO metabolites in MS and additional increase of serum ET-1 concentration in CHD. Serum CRP levels were increased in MS and CHD, being maximal in patients with Q-wave myocardial infarction (MI). In MI patients, the levels of TNF-alpha and IL-10 were decreased, while IL-6 concentration was elevated. Leptin concentration was increased in participants with MS only, or the combination of MI and MS. Adiponectin levels were decreased in MI patients, regardless of MS presence or absence.
Conclusion. The combination of MS and CHD was characterised by endothelial dysfunction. Serum inflammatory activity (increased CRP levels) was elevated in MS and was maximal in Q-wave MI. Serum levels of adipokines were dependent on MS presence or absence, with increased leptin concentration both at the risk factor stage and the Q-wave MI stage.

Aim. To identify the disturbances of vegetative heart regulation and their associations with systemic inflammation activity in patients with psoriatic arthritic (PsA).
Material and methods. The main group (MG) included 32 PsA patients without cardiovascular disease, CVD (mean age 44,62±11,6 years; mean PsA duration 10,32±10,2 years; 52,3% men). The control group (CG) included 25 healthy volunteers (mean age 40,33±11,8 years; 49,1% men). Time and spectral parameters of heart rate variability (HRV) were assessed. PsA activity was assessed by DAS index, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen (FG) levels. Cardiovascular risk (CVR) was calculated, based on the following parameters: lipid spectr arterial hypertension, body mass index, and family history of CVD.
Results. Compared to CG, all HRV parameters were affected in MG patients (p<0,01). HRV parameters were associated with PsA activity (ESR, CRP, FG, enthesitis), as well as with CVD risk factors (dyslipidemia, age).
Conclusion. In PsA patients, disturbed vegetative heart regulation was manifested in reduced HRV and activated sympathetic HRV component. These disturbances were associated with traditional CVD risk factors and systemic inflammation activity.

Aim. To investigate the associations between brachiocephalic atherosclerosis (BCAS) and arterial hypertension (AH); to study the potential for AH control after surgery.
Material and methods. The study included 70 patients (17 women, 53 men; mean age 62,5±7,5 years), who underwent planned surgery due to BCAS and carotid stenosis, CS (n=50) or brachiocephalic artery (BCA) malformation (n=20). AH duration varied from 4 months to 32 years. Levels of systolic blood pressure (SBP) were 115-192 mm Hg (mean SBP 151,5±27,26 mm Hg). Blood flow in aortal arch arteries was assessed by duplex BCA scanning. BP levels were registered within the 24 hours before the surgery, and then 3-5 days and 1-3 months after the intervention.
Results. In patients with CS, risk of BP elevation increased with age (р=0,04). Before the surgery, higher BP levels were registered in Group I patients: mean BP was 103,6±11,3 mm Hg vs. 91,7±6,6 mm Hg (р=0,00007). After the intervention, these differences were no longer observed. In patients with CS, post-intervention BP levels decreased due to reduction in both systolic BP (from 145,1±14,7 to 135,6±12,3 mm Hg; р=0,02) and diastolic BP (from 83,3±10,2 to 78,1±9,7 mm Hg; р=0,02). In patients with BCA malformation, no significant BP reduction was registered.

Conclusion. In BCAS patients, BP elevation was mostly explained by CS and progressed with age, while surgery facilitated BP reduction.

The review presents current experimental and clinical evidence on organo-protective effects of an ACE inhibitor quinapril. These effects are dependent on I/D polymorphism of ACE gene. The data available are consistent that quinapril could modulate this genetic risk factor, highly prevalent in Russian patients.

Acetylsalicylic acid (ASA) treatment of patients with cardiovascular disease (CVD) is one of the most effective methods for CVD event prevention. In a substantial proportion of the patients, however, long-term preventive ASA treatment compliance is low (44-71%). Low compliance is associated with reduced antiplatelet effects of ASA and a 2-3-fold increase in the risk of myocardial infarction (MI), ischemic stroke (IS), and other cardiovascular events. ASA therapy compliance could be improved by achieving better collaboration between doctors and patients, while educating patients and explaining the importance of following the doctors’ advice. In addition, enteric-coated ASA forms could play an important role in improving treatment tolerability and, therefore, increasing compliance. Other potentially effective measures include the use of modern packaging (calendar blisters) and information technologies (telephone communication, MGMM).

Aim. To study potential therapeutic approaches to the management of coronary heart disease (CHD) patients with hypercholesterolemia (HCH), who receive statins, but do not achieve target levels of total cholesterol (TCH) and low-density lipoprotein cholesterol (LDL-CH) in daily clinical practice.
Material and methods. The research project “Treat To Goal” is an observational study, involving 10 clinical centres in 6 Russian cities. In total, the study included 712 patients with CHD and HCH (386 men and 324 women; mean age 59 years), who received statins as secondary prevention measure, but did not achieve target levels of TCH and LDL-CH.
Results. In order to achieve target TCH levels, the lipid-lowering therapy was modified as follows: 42,4 % patients were administered a new statin; in 32,1 %, the “old” statin dose was titrated; in 25,5 %, statin therapy was combined with ezetimibe. The target TCH levels were achieved, respectively, in 33,5 %, 37,4 %, and 50,4 % of the patients. All three types of therapy modification were well tolerated and safe.

Conclusion. Combined lipid-lowering therapy with ezetimibe and statins is the optimal treatment option for Russian patients with CHD and HCH, who otherwise cannot achieve the target levels of blood lipids.

Although β-blockers have been endorsed by guidelines committees for the treatment of patients with hypertension, particularly those with significant CVD and high CVD risk, there are concerns about conventional β-blockers related to poorer clinical outcomes compared with other classes of antihypertensive agents, as well as deleterious effects on quality of life and lipid and carbohydrate metabolism. β-blockers comprise a heterogeneous group of antihypertensive agents, including nonselective agents, cardioselective, nonvasodilating agents, and vasodilating agents that either combine β-nonselectivity with β-blockade or possess cardioselectivity without β-blockade. The pharmacologic, mechanistic, and hemodynamic differences between conventional, nonvasodilating β-blockers and vasodilating β-blockers are discussed in this review, with a focus on the cardioselective vasodilating β-blocker nebivolol. These differences may have important clinical implications, particularly in the treatment of complicated hypertension, such as that associated with patients with diabetes or cardiometabolic syndrome, elderly patients, and African American patients, suggesting that mechanism of action may be an important consideration when choosing a β-blocker.

Heart failure (HF) is one of the leading death causes in patients with myocardial infarction (MI). The modern methods of reperfusion MI therapy, such as thrombolysis, surgery and balloon revascularization, even when performed early, could fail to prevent the development of large myocardial damage zones, followed by HF. Therefore, the researches have been searching for the methods which improve functional status of damaged myocardium. This review is focused on stem cell therapy, a method aimed at cardiac function restoration. The results of experimental and clinical studies on stem cell therapy in coronary heart disease are presented. Various types of stem cells, used for cellular cardiomyoplasty, are characterised. The methods of cell transplantation into myocardium and potential adverse effects of stem cell therapy are discussed.